Introduction to Evidence Based Medicine Loyola University Chicago Stritch School of Medicine

Why EBM? “Evidence based medicine is the basic science of clinical medicine.” - Vinay Prasad “Student, you do not study to pass the test. You study to prepare for the day when you are the only thing between a patient and the grave.” - @medicalaxioms (Dr. Mark Reid) “A 21st century clinician who cannot critically read a study is as unprepared as one who cannot take a blood pressure or examine the cardiovascular system.” BMJ 2008:337:704-705

Evidence Based Medicine “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” Sackett DL, et al. Evidence-based medicine: what it is and it isn’t. BMJ 1996;312:71-2.

Evidence Based Medicine Patient Values Medical Decision Clinical Expertise Research Evidence Integration of best research evidence with clinical expertise and patient values

4 “As” of EBM Ask an answerable question Acquire the best evidence Appraise the evidence for validity, clinical relevance and applicability Apply the evidence

Answerable Questions Background Questions: Foreground Questions: Who, what, where, when, why, how “What causes shingles?” Foreground Questions: Related to patient care decisions and actions PICO

PICO Formulate your clinical question: Patient or Population Be specific Intervention Comparison Group i.e. standard therapy, “gold standard” Outcome of Interest i.e. efficacy of therapy, mortality, specificity of diagnostic test “Surrogate” outcomes

Common Types of Questions Category How common is the problem? Prevalence Is early detection helpful? Screening Is the diagnostic test accurate? Diagnosis What will happen without intervention? Prognosis Does this intervention improve outcomes? Treatment Is this intervention harmful?

Sources of Evidence Quality

Why EBM? Clinical medicine: Does this practice improve my patient’s: Making a diagnosis Prescribing a treatment or performing a procedure Providing a prognosis Does this practice improve my patient’s: Survival? Health? Quality of life?

Evidence Based Medicine Patient Values Medical Decision Clinical Expertise Research Evidence Integration of best research evidence with clinical expertise and patient values

Resources Symptom to Diagnosis: An Evidence Based Guide, 3rd ed., Cifu et al. Highly recommend! Rational Medical Decision Making: A Case Based Approach. Rao, Gautham. Ending Medical Reversal. Cifu, Adam & Prasad, Vinayak. https://www.cebm.net/resources-2/ https://guides.mclibrary.duke.edu/ebm/home